Counseling Guidelines for Anticipated Postsurgical Improvements in Pain, Function, Mental Health, and Self-image for Different Types of Adult Spinal Deformity

Breton Line, Shay Bess, Virginie Lafage, Christopher Ames, Douglas Burton, Han Jo Kim, Munish Gupta, Robert Hart, Eric Klineberg, Michael Kelly, Khaled Kebaish, Richard Hostin, Gregory Mundis, Frank Schwab, Christopher Shaffrey, Justin S. Smith

Research output: Contribution to journalArticlepeer-review


Study Design.Retrospective analysis of a multicenter prospective adult spinal deformity (ASD) database.Objective.Quantify postoperative improvements in pain, function, mental health, and self-image for different ASD types.Summary of Background Data.Medical providers are commonly requested to counsel patients on anticipated improvements in specific health domains including pain, function, and self-image following surgery. ASD is a heterogeneous condition; therefore, health domain improvements may vary according to deformity type. Few studies have quantified outcomes for specific ASD types.Methods.Surgically treated ASD patients (=4 levels fused) prospectively enrolled into a multicenter database, minimum 2-year follow-up, were categorized into ASD types according to Scoliosis Research Society-Schwab ASD classification (THORACIC, LUMBAR, DOUBLE, SAGITTAL, MIXED). Demographic, radiographic, operative, and patient reported outcome measures (NRS back and leg pain, SRS-22r, SF-36) data were evaluated. Preoperative and last postoperative values for pain, physical and social function, mental health, and self-image were evaluated, improvements in each domain were quantified, and domain scores compared to generational normative values. Postoperative improvements were also calculated for three age cohorts (<45 yr, 45-65 yr, and >65 yr) within each deformity type.Results.359 of 564 patients eligible for study (mean age 57.9 yr, mean scoliosis 43.4°, mean SVA 63.3mm, mean 11.7 levels fused) had =2 yr follow-up. Domain improvements for the entire ASD population were 45.1% for back pain, 41.3% for leg pain, 27.1% for physical function, 35.9% for social function, 62.0% for self-image, and 22.6% for mental health (P<0.05). LUMBAR, SAGITTAL, and MIXED had greatest improvements in pain and function, while THORACIC and DOUBLE had greatest improvements in self-image. Self-image was the most impacted preoperative domain and demonstrated the greatest postoperative improvement for all ASD types.Conclusion.ASD patients demonstrated quantifiable postoperative improvements in pain, self-image, physical and social function, and mental health; however, improvements differed between ASD types. Further research is needed to understand specific patient expectations for ASD treatment.Level of Evidence: 3.

Original languageEnglish (US)
Pages (from-to)1118-1127
Number of pages10
Issue number16
StatePublished - Aug 15 2020


  • adult spinal deformity
  • improvement
  • patient-reported outcome measures
  • surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine


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